Treatment of cellulite and adipose tissue with mid-infrared radiation

ABSTRACT

A method and apparatus that will alter the fibrous strands in the fatty layers of the skin to reduce the appearance of cellulite and adipose tissue. Electromagnetic energy is used to selectively shrink or alternatively photoacoustically ablate the collagen in the constricting bands of connective tissue that causes the dimpled appearance of cellulite and adipose tissue while avoiding damage to the surrounding fatty cells.

RELATED APPLICATIONS

This application is a Continuation-In-Part of related U.S. patentapplication Ser. No. 11/675,028 filed Feb. 14, 2007 entitled TREATMENTOF CELLULITE AND ADIPOSE TISSUE WITH MID-INFRARED RADIATION, AttorneyDocket No. CTI-402, which is a Continuation-In-Part of related U.S. Pat.No. 7,217,265 issued May 15, 2007, application Ser. No. 11/131,577 filedMay 18, 2005 entitled TREATMENT OF CELLULITE WITH MID-INFRAREDRADIATION, Attorney Docket No. CTI-401, which both are incorporatedherein by reference in their entireties, and claims any and all benefitsto which they are entitled therefrom.

FIELD OF THE INVENTION

This invention relates to a treatment of cellulite and adipose tissuewith mid-infrared radiation, and more specifically to a method andsystem of selectively delivering energy to and thermally alteringstructures of the skin that cause the dimpled appearance of celluliteand adipose tissue.

BACKGROUND OF THE INVENTION

Cellulite is a condition of the skin characterized by the presence ofhard lumps of fatty material surrounded by fibrous connective tissuethat gives the skin an orange peel appearance. It is caused bydegeneration of subcutaneous blood vessels and results in a thinning ofthe dermis and pooling of body fluids. In general, adipose tissues isfatty tissue. Cellulite and adipose tissue occurs most often on thethighs, buttocks, and upper arms of Caucasian females and is oftenassociated with obesity.

Current treatments for cellulite and adipose tissue include mechanicalmassage, exercise, weight loss, diet, and topical drug treatment. Noneof these treatments are very effective or long lasting. There is a needfor a more effective and longer lasting way to smooth the skin of peoplesuffering from cellulite and adipose tissue.

Prior art has focused on damaging or removing the fatty tissue to curecellulite and adipose tissue. The method may not be effective due to thefact that connecting tissue, not fat, is the true cause of cellulite andadipose tissue. Heating of the fatty cells may be beneficial to acertain degree if the cells are encouraged to metabolize fat faster.However, the appearance as a result of damaged and dead fatty cells isnot attractive cosmetically unless the residue is removed in aliposuction therapy.

Other prior art teaches stimulating the generation of new collagen witha variety of optical, electromagnetic, and cosmetic means. U.S. Pat. No.6,443,914 issued Sep. 3, 2002 to Constantino teaches the use ofultrasound to build additional fibrous tissue through the normal bodyrepair mechanism.

U.S. Pat. No. 6,470,216 issued Oct. 22, 2002 to Knowlton teaches the useof a radio frequency generator to heat and ablate sub-dermal fat andregenerate collagen for skin tightening. RF energy is known to be highlyabsorbed in fatty tissue, which works in the opposite way to the presentinvention that avoids melting fat tissue.

U.S. Pat. No. 6,673,096 issued Jan. 6, 2004 to Lach teaches thesimultaneous delivery of infrared laser radiation in the range of 650 to1295 nm and massage devices. It is specifically stated that theobjective of the invention is to heat deep layers of tissue and causelipolysis or decomposition of fatty tissue. This range of wavelengthsmay heat the fatty tissue but not targeting the connective collagen asin the present invention. In addition, it is not stated that any fluencelevels is required and may be trying to perform bio-stimulation withlow-level radiation. The present invention clearly requires adequatelyhigh fluence levels to shrink or denature collagen and does not requirebio-stimulation to be effective.

U.S. Pat. No. 6,605,080 issued Aug. 12, 2003 to Altshuler et al. teachesa method of selectively targeting fatty tissue while avoiding damage totissue for the purpose of fat removal. The present invention proposesexactly the opposite in order to alter the collagen containingconnective tissue, which is the true cause of cellulite and adiposetissue. Altshuler et al. teaches that the optical absorption spectra offatty tissue is very different from the absorption spectra ofsurrounding tissue because of the presence of vibrational modes in themolecules of lipids that form fatty tissue. Since both fatty tissue andwater based tissue such as collagen can both be found in the same partsof the skin, the difference in these two optical absorption spectraallows a way to selectively target only one of the types of tissue whilereducing the heat absorbed by the other; and henceforth preserving it.Altshuler et al. teaches only the ability to heat fat while sparingtissue. Altshuler et al. does not teach that the opposite can be appliedunder special conditions. Moreover, Altshuler et al. does not mentioncellulite and adipose tissue in his work involved with differentwavelengths.

U.S. Pat. No. 5,304,169 issued Apr. 19, 1994 to Sand and U.S. Pat. No.4,976,709 issued Dec. 11, 1990 to Sand teach that collagen goes throughseveral stages of alteration when heated. At temperatures lower oraround 50° C., collagen is not affected. At about 60° C., collagen maycontract and shrink by about 30% without denaturization or permanentdamage to the structure. It has been shown that at these temperaturesthe shrinkage is long term and the collagen remains viable. Attemperatures>65 deg C. however the collagen will denaturize and lose itselasticity and collapse. When this happens to a connective fiber thefiber may weaken, stretch, and possibly break.

U.S. Pat. No. 6,413,253 issued Jul. 2, 2002 to Koop et al., U.S. Pat.No. 6,451,007 issued Sep. 17, 2002 to Koop et al. and U.S. Pat. No.5,885,274 issued Mar. 23, 1999 to Fullmer et al. teach a mid-IR laserdirected to the surface of the skin with energy densities of 10 to 150J/cm2 and pulse widths of 5 to 500 msec. A pulsed cryogen cooling systemis used to protect the epidermis by spraying a burst of R134a cryogenonto the treatment site immediately pre or post laser treatment.

ADVANTAGES AND SUMMARY OF THE INVENTION

The present invention relies on a combination of selective absorption bycollagen in fibrous strands or connective tissue and surface cooling toprevent epidermal damage. Strands that are pulling tightly on crevassesin the skin are heated to the point of denaturization, causing them torelax, expand and release the skin outward. On the other hand, strandsthat connect to outward bulging areas are heated merely to thenon-damaging collagen shrinkage temperature of about 65° C. so theypermanently contract and help smooth the skin surface.

Lasers in the wavelength region of 1.2 μm to 1.8 μm have been used formany years to shrink and damage collagen for dermatological purposes.Altshuler specifically points out that the result of utilizing awavelength region of 1.3 μm to 1.6 μm is extremely poor in his fatremoval invention because of the poor absorption in fat within theregion. Therefore, lasers in the region of 1.3 μm to 1.6 μm are verysuitable to be used to selectively shrink or damage collagen in thepresence of fatty tissue. The present invention recognizes this fact andcombines it in a novel and unique manner with the established goodcollagen absorption properties of that wavelength region to make a veryuseful invention. This particular aspect of the present inventionaccomplishes the opposite of Altshuler.

The selective nature of several bands of infrared electromagneticradiation allows the collagen to be heated without damage to thesurrounding fatty tissue. A combination of selective absorption bycollagen in fibrous strands and surface cooling to prevent epidermaldamage enables the present invention to work. Strands that are pullingtightly on crevasses in the skin are heated to the point ofdenaturization, causing them to relax, expand and release the skinoutward. On the other hand, strands that connect to outward bulgingareas are heated merely to the non-damaging collagen shrinkagetemperature of about 65° C. so they permanently contract and help smooththe skin surface.

In particular the Nd:YAG laser, when operated at a wavelength of 1.32um, is nearly perfect to selectively damage collagen in the presence offat. Wavelengths longer than 1.6 um will not be able to penetrate deepenough through the epidermal tissue to reach the target depth andwavelengths shorter than 1.3 um do not have enough water absorption toeffectively heat the collagen strands. However, when this invention isused in a percutaneous manner utilizing a fiber optic probe, wavelengthssuch as 2.0 um would be very effective.

The present invention provides a system and method to shrink some of thecellulite and adipose tissue connective strands while weakening andstretching others. Strands in the valleys of the cellulite and adiposetissue dimples are stretched and weakened while strands near the upperhill, top or surface of the dimple are shrunk to pull the top of thedimple inward. Precise control of the heating temperature is critical toaccomplish this simultaneously. Radiation fluence must be high (>1J/cm2) enough to cause permanent shrinkage or denaturization of thecollagen in the connective tissue. Low-level fluence (<1 J/cm2) will notwork to break connective tissue bonds, but they may stimulate fattytissue reduction. The improved method to accomplish this is to vary thepulse length of the laser so it will selectively cut or heat and shrinkthe appropriate target tissue.

The valleys of the cellulite and adipose tissue will be treated at ahigher temperature (>70 deg C.) to break the strands and the tops of thehills of the cellulite and adipose tissue will be treated at a lowertemperature (50 to 70 deg C.) to shrink the connective strands. Thefatty tissue may be heated enough to start to metabolize faster but theselective nature of energy at a wavelength of 1320 nm passes directlythrough the fat to target (i.e., be absorbed by) the fibrous strands.Also, the fat is useful to maintain a smooth and healthy appearance ofthe skin, in contradistinction to the teachings of the prior art.

Our new invention uses variable pulse lengths of laser energy to targetdifferent structures. Prior to this invention it was not known how totarget and damage fibrous strands without causing extensive damage tosurrounding tissue. However, by selecting an energy source that matchesthe transmission bands of fatty tissue and also matches the absorptionbands of collagen and simultaneously varies the pulse length of theenergy it is now possible to accomplish this. The pulse width of thelaser can be adjusted by the use of IGBT devices in the power supplythat are able to modulate the current flow to the flashlamp in the lasercavity. The pulse length of the laser can also be modulated by the useof discrete capacitors and inductors in the pulse forming network of thepower supply. The most effective pulse lengths for ablation or cuttingare in the microsecond region. Preferably 20 to 100 microseconds. Thisshort pulse is capable of generating sufficient peak energies togenerate plasma effects or photoacoustic effects at the fiber tip whichhave been shown to cut and ablate tissue with minimal coagulative sideeffects.

The most effective pulse lengths for connective tissue shrining orcoagulating are in the millisecond region. Preferably 0.5 to 50milliseconds. These long pulses will not generate plasma effects orphotocacoustic effects at the fiber tip but will gently heat and shrinkcollagen in the connective collagen tissue.

The present invention is utilized inserting a fiber optic energydelivery probe into the skin at the location of the fibrous strands andtreating them directly. The use of fiber optic delivery systems forlaser energy is well known in the industry, but the use of thistechnique with a selectively absorbing energy source to treat celluliteand adipose tissue is not obvious. Prior attempts to try this have usedenergy sources that did not distinguish between the collagen and the fatand the result was extensive damage to all the surrounding tissue and apoor cosmetic result. An additional improvement to this percutaneousapproach is to use a fiber optic probe that directs the energy out thefront or side of the distal end. This allows the probe to be placedalong side the connective strands under the skin and cut in a line withthe energy pointed away from the skin surface. It is also possible toperform this procedure under ultrasound imaging to more accuratelylocate and cut the connective strands. The use of energy in the range of1.3-1.6 μm or 1.9 to 2.2 μm allows the strands to be cut withoutaffecting the surrounding fatty tissue. In this embodiment the use ofthe more highly absorbing 2.0-3.0 um radiation such as produced by aThulium, Holmium, or Erbium doped YAG crystal may be more appropriate asthe use of a percutaneous fiber optic makes it unnecessary to opticallypenetrate the epidermis to reach the target tissue.

Lasers that could be used for this invention include Nd:YAG at 1320 nm,Diode lasers at 1450 nm, ER:Glass laser at 1540 nm fiber lasers at1550-1600 nm, Holmium or Thulium lasers at 1.9-2.2 um or Erbium lasersat 2.9 um.

It is yet a further object and advantage of the present invention toprovide a method for treating cellulite and adipose tissue by moving theend of the optical fiber past the end of the blunt-end cannula so thatheat does not impinge on the needle tip and heat it up. The smooth andblunt end of the cannula, rather than sharpened piercing tip, preventsinadvertent puncture of skin and is safer overall to use. The apparatusincludes a relatively stiff or rigid polyimide coated optical fiber,optionally cleaved flat or at an angle, providing the advantage of notrequiring the use of the cannula and resistance by the fiber to breakageparticularly during placement or use. By extending the firing tip of thefiber optic past the blunt distal end of the cannula, the firing tip iswell beyond the cannula and there is no risk of overheating the cannula.The fiber can also be made of sapphire crystal. This material is strongenough to not break in the tissue and can transmit laser wavelengths inthe 3 um band such as the Erbium Yag laser at 2.94 um.

The coating is made of a material which absorbs the laser energy at thewavelength utilized. During use, it is an advantage to cause the distalend of the coating to burn to a char during laser delivery. The charheats to a very high temperature and acts as a hot tip ablation device,having a hat, ablative cutting surface. In an embodiment of the presentinvention, the method using a pulsed laser in conjunction with a coatedfiber such that the rapid temperature rise at the charred fiber tipcauses an acoustic explosion which ablates and disrupts tissue.

The fiber can be inserted beyond or past the end of the cannula tip sothat it is no longer adjacent the tip, increasing maneuverability andimproving the efficiency of the cutting tip. Additionally, by moving thedistal tip of the optical fiber well past the tip of the cannula thereis less chance that the metal cannula will be heated by the laser beamexiting from the emitting face of the fiber, it provides an advantage tominimize heating of the tip of the cannula which if heated may causeburns to the patient's skin as it is introduced and/or withdrawn before,during or after use.

It is also an object and advantage of the invention to use a Touhy Borstclamp on the fiber as a marker to guarantee that the fiber is wellbeyond the cannula tip. Using an aiming beam up to 10 times or morebrighter than the conventional aiming beam, the practitioner can easilydetermine exactly where the fiber tip is and be able to move it wellpast the cannula tip before firing it to ablate the undesirableconnective tissue.

Further objects and advantages of the present invention will be comeapparent through the following descriptions, and will be included andincorporated herein.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a graph illustrating the infrared absorption curves ofcollagen/water and human fatty tissue 124.

FIG. 2 is a graph illustrating the ratio of the coefficients of infraredabsorption of human fatty tissue 124 and collagen as a function ofwavelength.

FIG. 3 is a schematic representation of a flashlamp pumped solid statelaser.

FIG. 4 is a schematic representation of an electronic pulse formingnetwork used to produce pulsed laser output.

FIG. 5 is a photo of an oscilloscope readout illustrating a flashlamppulse generated by the pulse forming network shown in FIG. 4.

FIG. 6 is a schematic representation of an Isolated Gate BipolarTransistor (IGBT) system suitable for producing pulsed laser output.

FIGS. 7A, 7B and 7C are photos of an oscilloscope readout illustratingflashlamp pulses produced by the IGBT system of FIG. 6.

FIG. 8 is a schematic representation of a control system suitable forproducing pulsed laser output.

FIG. 9 is a representative detail schematic diagram of an embodiment ofthe cellulite and adipose tissue treatment system 100′ of the presentinvention.

FIG. 10 is a representative detail schematic diagram of anotherembodiment of the cellulite and adipose tissue treatment system 100″ ofthe present invention.

FIG. 11 is a representative detail isometric drawing of an embodiment ofthe cellulite and adipose tissue treatment system 200 of the presentinvention.

FIGS. 12A, 12B and 12C are representative section views of an embodimentof the firing tip 614′ best shown in FIGS. 10 and 11.

DETAILED DESCRIPTION OF THE EMBODIMENT

The description that follows is presented to enable one skilled in theart to make and use the present invention, and is provided in thecontext of a particular application and its requirements. Variousmodifications to the disclosed embodiments will be apparent to thoseskilled in the art, and the general principals discussed below may beapplied to other embodiments and applications without departing from thescope and spirit of the invention. Therefore, the invention is notintended to be limited to the embodiments disclosed, but the inventionis to be given the largest possible scope which is consistent with theprincipals and features described herein.

It will be understood that in the event parts of different embodimentshave similar functions or uses, they may have been given similar oridentical reference numerals and descriptions. It will be understoodthat such duplication of reference numerals is intended solely forefficiency and ease of understanding the present invention, and are notto be construed as limiting in any way, or as implying that the variousembodiments themselves are identical.

Definitions

An “absorption coefficient” of a substance is a measure of the fractionof incident light that is absorbed when light is passed through thesubstance. The absorption coefficient (typically in units of cm.sup.-1)varies with the nature of the absorbing substance and with thewavelength of the light.

“Collagen” as used herein refers to any of the several types ofcollagen.

Collagen biosynthesis is said to be “inhibited’ when cells treated withthe claimed methods secrete collagen at a rate that is less than about70% of that of untreated cells. Preferably, treated cells secretecollagen at a rate that is less than about 50%, and more preferably lessthan about 30% of the rate at which untreated cells secrete collagen.

Collagen biosynthesis is said to be stimulated when cells treated withthe claimed methods secrete collagen at a rate that is greater thanabout 110% of the rate at which untreated cells synthesize collagen.Preferably, treated cells secrete collagen at a rate that is about 150%,and more preferably greater than about 200% greater than that ofuntreated cells.

“Monochromatic” light is of one wavelength or a narrow range ofwavelengths. If the wavelength is in the visible range, monochromaticlight will be of a single color. As used herein, “monochromatic” refersto light that has a bandwidth of less than about 100 nm. Morepreferably, the bandwidth will be less than about 10 nm, and mostpreferably less than about 1 nm.

“Non-coherent light energy” is light that is non-laser. Unlike laserlight, which is characterized by having its photon wave motions inphase, the wave motions of the photons that make up non-coherent lightare in a randomly occurring phase order or are otherwise out of phase.

A “wound” as used herein, refers to any damage to any tissue in a livingorganism. The tissue may be an internal tissue, such as the stomachlining or a bone, or an external tissue, such as the skin. As such, awound may include, but is not limited to, a gastrointestinal tractulcer, a broken bone, a neoplasia, and cut or abraded skin. A wound maybe in a soft tissue, such as the spleen, or in a hard tissue, such asbone. The wound may have been caused by any agent, including traumaticinjury, infection or surgical intervention.

A “growth factor” as used herein, includes any soluble factor thatregulates or mediates cell proliferation, cell differentiation, tissueregeneration, cell attraction, wound repair and/or any developmental orproliferative process. The growth factor may be produced by anyappropriate means including extraction from natural sources, productionthrough synthetic chemistry, production through the use of recombinantDNA techniques and any other techniques, including virally inactivated,growth factor(s)-rich platelet releasate, which are known to those ofskill in the art. The term growth factor is meant to include anyprecursors, mutants, derivatives, or other forms thereof which possesssimilar biological activity(ies), or a subset thereof, to those of thegrowth factor from which it is derived or otherwise related.

FIG. 1 is a graph illustrating the infrared absorption curves ofcollagen/water and human fatty tissue 124. The graph illustrates thecoefficient of absorption (CM-1) of collagen and of human fatty tissue124 as a function of wavelength respectively. As shown in FIG. 1, theoptical absorption spectra of fatty tissue 124 is very different fromthat of collagen because of the presence of vibrational modes in themolecules of lipids that form fatty tissue 124. The coefficient ofabsorption of human fatty tissue 124 is extremely low in the wavelengthregion of 1.3 μm to 1.6 μm indicating poor absorption in fat within theregion. The peak coefficient of absorption of fatty tissue 124 absorbingbands are 0.90μ-0.93 μm, 0.19 μm-0.122 μm, and 0.17 μm-0.173 μm.However, as also shown in FIG. 1, the coefficient of absorption ofwater-based collagen is relatively high in the wavelength region of 1.3μm to 1.6 μm indicating good infrared absorption. The system 100 ofpresent invention combines this understanding with the established highcoefficient of absorption of collagen in that wavelength region.Therefore, lasers having output in the region of between about 1.3 μmand about 1.6 μm and between about 1.9 um and about 2.2 um are verysuitable to selectively shrink or denaturize collagen containingconnective tissue 122 in the presence of fatty tissue 124.

FIG. 2 is a graph illustrating the ratio of the coefficients of infraredabsorption of human fatty tissue 124 and collagen as a function ofwavelength. As indicated, the higher the ratio, the larger thedifference between infrared absorption of fatty tissue 124 and that ofcollagen; and vice versa. As shown in FIG. 2, there are windows wherethe ratio between fatty tissue 124 and collagen is the lowest, these arecalled “therapeutic windows”. “Therapeutic windows” indicate the rangeof wavelengths where collagen containing connective tissue 122 may beeffectively targeted with minimal damage to fatty tissue 124. As shownin FIG. 2, these windows occur in the wavelength range of 1.3 μm-1.6 μmand 1.9 μm-2.2 μm respectively. Wavelengths around 3 um are highlyabsorbed in both fat and tissue and can be used to cut tissue locateddirectly in front of the fiber probe.

Operation of System to Modulate Laser Pulse Widths

FIG. 3 is a schematic representation of a laser that utilizes aflashlamp to pump the laser crystal. The use of a flashlamp is method oflaser pumping that is generally known to those skilled in the art. Itwas one of the first methods used to produce laser energy, and is stillin wide use because of it low cost and ability to produce large amountsof pulsed energy. The method described herein is a standard way toproduce pulsed energy from a solid state laser such as an Nd:YAG orother crystalline medium laser. This method has been taught for manyyears for other applications, but is adapted to produce the type oflaser output used by the methods described herein. The prior artapplications utilize continuous output semiconductor lasers that do notutilize flashlamp pumping. Semiconductor or diode lasers are activatedby directly stimulating the medium with a low voltage direct currentand, by design, cannot store and output giant energy pulses. Theexemplary power supply described below is intended to illustrate atechnique that is used to produce pulsed laser operation and to showthat it is fundamentally different from continuous laser operation forthe present methods.

A pulsed laser flashlamp 810 is a tube of glass or quartz that is sealedoff at each end and contains a rare gas such as Xenon or Krypton.Electrical contacts through each end connect to an anode and a cathodeinside the glass tube. When a high voltage is applied to the ends of thelamp it will discharge with a broad band white light. The lamp is placedin close proximity to the lazing crystal 812 so that the crystal absorbsthe light energy. The crystal 812 stores this energy until a lazingthreshold is reached when the energy is emitted through a process calledstimulated emission. A set of aligned mirrors 814 around the crystal 812allows selection of the wavelength and direction for this energy topropagate and to be coupled out of the crystal 812. Lasers that can beoperated in giant pulse mode require lazing mediums that can store andthen selectively release large amounts of energy. Solid state crystallasers such as Nd:YAG lasers are optimal for this purpose. Semiconductoror diode lasers do not store significant amounts of energy and thereforecan only be operated in continuous or very low energy per pulse modes.

FIG. 4 is a schematic representation of a power supply 820 that can beused to pulse the flashlamp 810 to produce large energy pulses used inthe methods described herein. A pulse lamp driving circuit typicallycontains a high voltage power supply 822, a main storage dischargecapacitor 824, an inductor 826 to match lamp impedance and to controlthe pulse length, a lamp 828, and a triggering mechanism, such as atrigger transformer 852 described below in relation to FIG. 6, toinitiate ionization in the gas in the lamp so that the main dischargecurrent can flow through the lamp.

When the lamp 828 is non-ionized, it has a very high impedance and thusinitially all the power supply current flows into the capacitor 824. Ifthe voltage across the capacitor 824 or the trigger circuit reaches avalue equal to the breakdown voltage of the lamp 828, ionization of thelamp 828 gas starts to occur and its impedance begins to fall. Ifsufficient charge is available, the plasma of ionized gas in the lamp828 completely fills the bore and the lamp radiates energy in the formof light. Eventually all of the energy in the capacitor 824 is expendedand the lamp 828 returns to a de-ionized state. This process can berepeated with a repetition rate that can be from a single isolated pulseto thousands of times every second. The energy discharges from thecapacitor 824 through the flashlamp 828 with a pulse length that isdetermined by the values of the capacitor 824 and inductor 826 that hasbeen selected for the pulse forming network. This pulse length can beshown to be: T=1/3 (LC)½, where L is the value of the inductor 826 and Cis the value of the capacitor 824 in the network.

Since the crystalline laser medium 812 will absorb white light and emitcoherent monochromatic light in close agreement with the flashlamppulse, proper selection of the flashlamp pulse length provides a methodfor controlling the giant pulse length of a solid state laser. It iscontrolled by the choice of the value of the main discharge capacitors824 and inductors 826. However, the laser operates most efficiently whenthe flashlamp pulse length closely matches the fluorescent lifetime ofthe lasing medium and when the PFN (pulse forming network) matches theimpedance of the lamp 828. For a typical Nd:YAG laser, this is about 200μseconds. FIG. 5 is a photo of an oscilloscope readout illustrating anexemplary flashlamp pulse generated by the pulse forming network shownin FIG. 4.

The energy per pulse is determined by the energy stored in the maincapacitor. This energy can be calculated to be: E=1/2 C(V)2, where V isthe voltage that the capacitor is charged to. The output lasing energywill be a percentage of the flashlamp pump energy within the coolingconstraints of the rest of the laser. For Nd:YAG crystals usually about3% of the pump energy emits as coherent laser energy.

For the present endovenous laser treatment methods, typical values forthe components are:

C=10 to 1000 μFarads

L=10 to 5000 μiHenrys

V=200 to 2000 volts

These values can produce pulse lengths from 3 to 800 μseconds, pumpenergies from 0.2 Joules to 2000 Joules per pulse, and laser outputenergies of 6 millijoules to 60 joules per pulse. These values have beenshown to be effective in reducing the coagulum that develops at the tipof an endovenous laser fiber during treatment.

FIG. 6 illustrates an alternative electronic switching device referredto as an IGBT (Isolated Gate Bipolar Transistor), which can be used togenerate pulsed energies in a flashlamp of the same values as acapacitive, inductive pulse forming network. The IGBT circuit includes ahigh voltage power supply 842, a main storage discharge capacitor 844,an electric switch 846, a lamp 848, a simmer supply 850, and a triggertransformer 852 to initiate ionization in the gas in the lamp so thatthe main discharge current can flow through the lamp. The device shownin FIG. 6 is usually operated at a fixed capacitor voltage and controlsthe energy discharge into the flashlamp by controlling the pulse lengthof the discharge. The IGBT device can shut off the current at any time,as opposed to a conventional transistor which cannot be controlled onceit is turned on. A trigger transformer 852 is used to strike a highvoltage arc in the flashlamp 848 to initiate a plasma current in thelamp of about 100 mamps. This plasma is maintained by a current limitingpower supply called a simmer supply 850 and allows the discharge of ahigh current flashlamp pulse controlled by the IGBT 846.

For endovenous laser treatment methods, typical values for the capacitor844 and voltage 842 to control flashlamp pulses are:

C=1000 to 30,000 μFarads

V=100 to 500 volts

These values can produce pulse lengths from 1 to 5000 μseconds, pumpenergies from 0.2 to 2000 joules per pulse, and laser output energiesfrom 6 millijoules to 60 joules per pulse. FIGS. 7A-C are photos ofoscilloscope readouts illustrating exemplary flashlamp pulses producedby the IGBT system of FIG. 6. For example, FIG. 7A illustrates a pulselength of about 110 μseconds, FIG. 7B illustrates a pulse length ofabout 250 μseconds, and FIG. 7C illustrates a pulse length of about 550μseconds.

Those skilled in the art will recognize that there are other availablemethods to pulse lasers, but that the two methods described hereinutilizing flashlamp pulse sources represent efficient and effectivemethods for producing high energy short pulses that are sufficient tovaporize blood coagulum formed at the tip of a fiber optic catheter in ablood vessel. Other laser pulse methods include the use of opticalswitches such as Pockels Cells or saturable dyes that bleach whenintracavity energy densities exceed a calculated minimum. These methodsproduce very short pulses that can easily damage fiber optic deliverydevices and are not preferred. It is also possible to mechanicallyshutter a continuous laser, but this would result in a very large andinefficient laser in which over 90% of the laser output would be wasted.

FIG. 8 is a schematic representation of the controls needed to modifythe pulse length and energy of a flashlamp pulsed laser. The energy andrepetition rate of the pulsing is selected on a control panel attachedto a central processing unit (CPU) 860. The CPU 860 sends controlsignals 862 a-b to the high voltage power supply 864 and the pulseforming network 866 or electronic switch to select pulse energy andwidth. After each pulse, feedback signals 868 a-c from the high voltagepower supply 864, the pulse forming network 866, and the laser output870 are routed back to the CPU 860 and compared for the correct energyand pulse. Energy and pulsing are thereby controlled on a real timebasis.

Collagen goes through several stages of alteration when heated. Attemperatures lower or around 50° C., collagen is not affected. At about60° C., collagen may contract and shrink by about 30% withoutdenaturization or permanent damage to the structure. It has been shownthat at these temperatures the shrinkage is long term but the collagenremains viable. At temperatures greater than 65° C. however the collagenwill denaturize and lose its elasticity and simply collapse. When thishappens to a collagen containing connective fiber 122, the connectivetissue 122 may weaken, stretch, and possibly break.

A principle of treatment system 100 of the present invention is toselectively shrink some of the cellulite connective tissue 122 whileweakening and stretching others; all while neighboring fatty tissue 124is avoided. As shown best in FIG. 9, multiple bursts of pulsed energy504, which is ultimately from appropriate energy source 102 thatcompares and optionally matches the transmission bands of fatty tissue124 and the absorption bands of collagen, are directed to target tissue120. The pulsed energy 504 heats up connective tissue strands 122 in thevalleys 510 of the cellulite and adipose tissue dimples to thetemperature range of 70° C. plus so they are stretched and weakened. Atthe same time, connective tissue strands 122 comprising the hill topsurface 512 of the cellulite and adipose tissue dimples are heated tothe temperature range between 50° C. and 60° C. so they are shrunk to acertain degree. As a result, there is an inward pull in the directionindicated as F generated at the top of the dimples 512, collectively theappearance of cellulite and adipose tissue is eliminated and skinsurface 116 is smoothed. The fatty tissue 124 may be heated enough tostart to metabolize faster but the selective nature of laser energy 504such as Nd:YAG at 1.32 μm will allow most of the energy to transmitdirectly through the fat tissue 124 to target the collagen containingconnective fibrous strands 122. Also, the fat tissue 124 is needed tomaintain a smooth and healthy appearance of the skin. As opposed tomethods and systems of the prior art, fatty tissue 124 is spared duringcellulite and adipose tissue treatment of the present invention.

FIG. 9 is a representative detail schematic diagram of an embodiment ofthe cellulite and adipose tissue treatment system 100 of the presentinvention. As shown, the laser energy 110 from the energy source 102 isdirected into delivery device 112 which may be a fiber optic,articulated arm, or an electrical cable etc. At the distal end ofdelivery device 112 is a front or side fire fiber optic probe 610 fordirecting the laser energy 504 inside the target tissue 120. The frontor side fire fiber optic probe 610 includes a long cannula 612 for easyaccess and a forward or side-firing tip 614 for safe treatment, whichmay optionally comprise mechanical breaking of the fibers when incontact.

In one embodiment, a fiber optic probe 610 is inserted into the targettissue 120 at the location of the connective fibrous tissue 122.Multiple bursts of laser energy 504, which are from appropriate energysource 102 that matches the transmission bands of fatty tissue 124 andthe absorption bands of collagen, are emitted and treat connectivefibrous tissue 122 directly. The use of fiber optic delivery systems forlaser energy is well known within the industry, but the use of thistechnique with a selectively absorbing energy source to treat celluliteand adipose tissue is not obvious. Prior attempts to try this have usedenergy sources that did not distinguish between the collagen and the fatand the result was extensive damage to all the surrounding tissue and apoor cosmetic result. An additional improvement to this percutaneousapproach is to use a fiber optic probe 610 that directs the energy outthe front or side of the forward or side-firing tip 614. This allows theprobe 610 to be placed along side the connective strands 122 under theskin surface 116 and cut in a line with the pulsed energy 504 pointedtowards the skin surface 116. In one alternative embodiment, it is alsopossible to perform this procedure under ultrasound imaging to moreaccurately locate and treat the connective strands 122, such as thoselocated in the valleys 510 between the dimples of the cellulite andadipose tissue as opposed to those located in the surface tissue 512 ofthe cellulite tissue. The use of energy in the range of 1.3 μm-1.6 μm or1.9 μm to 2.2 μm allows the connective tissue 122 to be treated withoutaffecting the surrounding fatty tissue 124. In one embodiment, the useof a more highly absorbing 2.0 μm laser energy 110 such as produced by aThulium or Holmium doped YAG crystal may be more appropriate as the useof a percutaneous fiber optic makes it unnecessary to opticallypenetrate the epidermis to reach the target tissue 120.

FIG. 10 is a representative detail schematic diagram of anotherembodiment of the cellulite and adipose tissue treatment system 100′ ofthe present invention. As shown, the laser energy 110 from the energysource 102 is directed into delivery device 112 which may be a fiberoptic, articulated arm, or an electrical cable etc. At the distal end ofdelivery device 112 is a front fire fiber optic probe 610′ for directingthe pulsed energy 504 inside the target tissue 120. The front fire fiberoptic probe 610′ includes a long cannula 612′ for easy access and aforward firing tip 614′ for safe treatment, which may optionallycomprise mechanical breaking of the fibers when in contact.

FIG. 11 is a representative detail isometric drawing of an embodiment ofthe cellulite and adipose tissue treatment system 200 of the presentinvention. FIGS. 12A, 12B and 12C are representative section views of anembodiment of the firing tip 614′ best shown in FIGS. 10 and 11.

As described above with regard to FIG. 10, an embodiment of the frontfire fiber optic probe 610′ comprises a coated fiber optic laserdelivery device 112′. The coated fiber optic 112′ is secured into aTouhy Borst or equivalent clamp 210. A side-port 220 is useful foroptional aspiration of liquified fat, blood or other tissue. As shown,the Touhy Borst clamp adapter 210 is used to fix the length of the fiber112′ so that the distal tip 230 of the fiber 112′ is guaranteed toextend beyond the distal tip 226 of the cannula 222. The Touhy Borstadapter 210 essentially clamps to the fiber 112′ to mark properextension of the fiber tip 230 past the distal end 226 of the cannula222.

As described above, the present invention is a method for treatingcellulite and adipose tissue by moving the distal tip 230 of the opticalfiber 112′ past the blunt end 226 of the cannula 222 so that heat doesnot impinge on the blunt end 226 and heat it up. The smooth and bluntend 226 of the cannula 222 prevents inadvertent puncture of skin and issafer overall to use. The apparatus includes a relatively stiff or rigidpolyimide coated optical fiber 112′, optionally cleaved flat or at anangle, providing the advantage of not requiring the use of the cannula222 and resistance by the fiber 112′ to breakage particularly duringplacement or use. By extending the firing tip 230 of the fiber optic112′ past the blunt distal end 226 of the cannula 222, the firing tip230 is well beyond the cannula 222 and there is no risk of overheatingthe cannula 222.

The cladding 232 of the fiber 112′ is not stripped off prior to use. Thefiber 112′ can be cleaved through the entire coating 232. Thus, laserenergy heats the coating 232 creating a carbonized tip 234. Thus, thelaser energy goes mostly into heating the tip 230 and directly to targettissue. In one embodiment, the pulsed hot tip laser explodes the tissueand fat without extensive thermal effects. Fat is liquified or ablated,and the pulsed laser creates an explosively hot cutting tip 230.

The fiber coating 232 is made of a material which absorbs the laserenergy at the wavelength utilized. During use, it is an advantage tocause the distal end of the coating 232 to burn to a char 234 duringlaser delivery. The char 234 heats to a very high temperature and actsas a hot tip ablation device, having a hat, ablative cutting surface. Inan embodiment of the present invention, the method using a pulsed laserin conjunction with a coated fiber 112′ such that the rapid temperaturerise at the charred fiber tip 230 causes an acoustic explosion whichablates and disrupts tissue. The pulsed energy ablates a zone 236 oftissue with minimal peripheral or other unintended thermal damage.Photoacoustic ablation is similar to CW Nd:YAG sapphire crystal contacttip technology. The tip 230 requires an “initiation” to enable thecarbon char 234 at the distal end 230 of the coated fiber 112′ tofunction as a hot cutting tip. The carbon layer 234 on the tip 230absorbs laser energy, creating an intense white hot ablation point. Thesystem adds short pulse length pulsed energy to achieve a white hotacoustic ablation mechanism. Thus, ablation of connective tissue occursat low energy fluences, with resultant minimal collateral damage.

The tip 230 of the coated fiber 112′ can be inserted beyond or past thetip 226 of the cannula 222 so that it is no longer adjacent the cannulatip 226, increasing maneuverability and improving the efficiency of thecutting tip 230. Additionally, by moving the distal tip 230 of theoptical fiber 112′ well past the tip 226 of the cannula 222 there isless chance that the metal cannula 222 will be heated by the laser beamexiting from the emitting face or tip 234 of the fiber 112′, it providesan advantage to minimize heating of the tip 226 of the cannula 222 whichif heated may cause burns to the patient's skin as it is introducedand/or withdrawn before, during or after use.

It is also possible to use a Touhy Borst clamp 210 on the fiber 112′ asa marker during other types of visualization including optical, X-ray,sonic imaging, MRI, CAT-scan or other spectral analysis visualization,to guarantee that the fiber 112′ is well beyond the cannula tip 226.Using an aiming beam such as element 137 shown in FIG. 4, up to 10 timesor more brighter than the conventional aiming beam, the practitioner caneasily determine exactly where the fiber tip 230 is and be able to moveit well past the cannula tip 226 before firing it to ablate theundesirable connective tissue.

Fat is very difficult to target using conventional selectivephotothermolysis. Table 1 shows the optical absorption of laser energycreated by an Nd:YAG laser in fat tissue.

Optical absorption of Nd:YAG wavelengths: TABLE 1 Optical Absorption ofFat 1064 Fat = 0.06 Tissue = 0.14 1320 Fat = 0.16 Tissue = 1.60The treatment of the present invention does not depend upon opticalabsorption properties of fat.

The pulsed hot tip laser energy explodes tissue and fat withoutextensive thermal effects. Fat is liquefied, not cooked. Thus, pulsedenergy at 1320 nm wavelength ablates very similar to pulsed energy at1064 nm. Furthermore, 1320 nm also tightens the sub dermal collagenbetter than energy at 1064 nm.

Table 2 shows a comparison of the collateral tissue damage caused byvarious types of electromagnetic energy. TABLE 2 Collateral TissueDamage Device/Wavelength Power Depth Electrocautery #4 cut mode 924 μmHo:YAG 2.1 μm 4 Watts 321 μm CO2 10.6 μm 3 Watts 221 μm Nd:YAG 1.06 μm 3Watts 132 μm Nd:YAG 1.32 μm 3 Watts 127 μm Nd:YAG 1.32 μm 4 Watts 181 μm

Table 3 shows the effect of pulse width, ablation width and coagulationwidth. TABLE 3 Effect of Pulse Width Time Ablation Width CoagulationWidth 120 μsec 987 μm 49 μm 500 μsec 593 μm 63 μm 1200 μsec  515 μm 81μm

In conclusion, shorter pulses ablate more tissue with less collateraldamage to tissue. Energy at 1320 nm used for acoustic ablation showsless collateral damage than electrocautery, CO₂, and Holmium lasers in apulsed cutting mode. This is the opposite action predicted bynon-contact thermal and selective photothermolysis theory. Thus, it hasbeen shown that acoustic ablation is a new mechanism to treat tissuewith low absorption. According to the present invention describedherein, treatment can be made using a variable pulsed laser that canswitch between microsecond ablative pulses and millisecond thermalpulses.

The present invention incorporates U.S. Pat. No. 5,820,626 issued Oct.13, 1998 to Baumgardner and U.S. Pat. No. 5,976,123 issued Nov. 2, 1999to Baumgardner et al. herein by reference in their entirety, withoutlimitations, and in particular with regard to their teachings regardingsurface cooling of tissue during laser treatment.

Wound Healing and Growth Factors; Mesotherapy and Lipotherapy

When a tissue is injured, polypeptide growth factors, which exhibit anarray of biological activities, are released into the wound where theyplay a crucial role in healing (see, e.g., Hormonal Proteins andPeptides (Li, C. H., ed.) Volume 7, Academic Press, Inc., New York N.Y.pp. 231 277 (1979) and Brunt et al., Biotechnology 6:25 30 (1988)).These activities include recruiting cells, such as leukocytes andfibroblasts, into the injured area, and inducing cell proliferation anddifferentiation. Growth factors that may participate in wound healinginclude, but are not limited to: platelet-derived growth factors(PDGFs); insulin-binding growth factor-1 (IGF-1); insulin-binding growthfactor-2 (IGF-2); epidermal growth factor (EGF); transforming growthfactor-.alpha. (TGF-.alpha.); transforming growth factor-.beta.(TGF-.beta.); platelet factor 4 (PF-4); and heparin binding growthfactors one and two (HBGF-1 and HBGF-2, respectively).

PDGFs are stored in the alpha granules of circulating platelets and arereleased at wound sites during blood clotting (see, e.g., Lynch et al.,J. Clin. Invest. 84:640 646 (1989)). PDGFs include: PDGF; plateletderived angiogenesis factor (PDAF); TGF-.beta.; and PF4, which is achemoattractant for neutrophils (Knighton et al., in Growth Factors andOther Aspects of Wound Healing: Biological and Clinical Implications,Alan R. Liss, Inc., New York, N.Y., pp. 319 329 (1988)). PDGF is amitogen, chemoattractant and a stimulator of protein synthesis in cellsof mesenchymal origin, including fibroblasts and smooth muscle cells.PDGF is also a nonmitogenic chemoattractant for endothelial cells (see,for example, Adelmann-Grill et al., Eur. J. Cell Biol. 51:322 326(1990)).

IGF-1 acts in combination with PDGF to promote mitogenesis and proteinsynthesis in mesenchymal cells in culture. Application of either PDGF orIGF-1 alone to skin wounds does not enhance healing, but application ofboth factors together appears to promote connective tissue andepithelial tissue growth (Lynch et al., Proc. Natl. Acad. Sci. 76:12791283 (1987)).

TGF-.beta. is a chemoattractant for macrophages and monocytes. Dependingupon the presence or absence of other growth factors, TGF-.beta. maystimulate or inhibit the growth of many cell types.

Other growth factors, such as EGF, TGF-.alpha., the HBGFs and osteogeninare also important in wound healing. Topical application of EGFaccelerates the rate of healing of partial thickness wounds in humans(Schultz et al., Science 235:350 352 (1987)). Osteogenin, which has beenpurified from demineralized bone, appears to promote bone growth (see,e.g., Luyten et al., J. Biol. Chem. 264:13377 (1989)). In addition,platelet-derived wound healing formula, a platelet extract which is inthe form of a salve or ointment for topical application, has beendescribed (see, e.g., Knighton et al., Ann. Surg. 204:322 330 (1986)).

The heparin binding growth factors (HBGFs), including the fibroblastgrowth factors (FGFs), which include acidic HBGF (aHBGF also known asHBFG-1 or FGF-1) and basic HBGF (bHBGF also known as HBGF-2 or FGF-2),are potent mitogens for cells of mesodermal and neuroectodermallineages, including endothelial cells (see, e.g., Burgess et al., Ann.Rev. Biochem. 58:575 606 (1989)). In addition, HBGF-1 is chemotactic forendothelial cells and astroglial cells. Both HBGF-1 and HBGF-2 bind toheparin, which protects them from proteolytic degradation. The array ofbiological activities exhibited by the HBGFs suggests that they play animportant role in wound healing.

Basic fibroblast growth factor (FGF-2) is a potent stimulator ofangiogenesis and the migration and proliferation of fibroblasts (see,for example, Gospodarowicz et al., Mol. Cell. Endocinol. 46:187 204(1986) and Gospodarowicz et al., Endo. Rev. 8:95 114 (1985)). Acidicfibroblast growth factor (FGF-1) has been shown to be a potentangiogenic factor for endothelial cells (Burgess et al., supra, 1989).Other FGF's may be chemotactic for fibroblasts. Growth factors are,therefore, potentially useful for specifically promoting wound healingand tissue repair.

“HBGF-1,” which is also known to those of skill in the art byalternative names, such as endothelial cell growth factor (ECGF) andFGF-1, as used herein, refers to any biologically active form of HBGF-1,including HBGF-1.beta., which is the precursor of HBGF-1.alpha. andother truncated forms, such as FGF. U.S. Pat. No. 4,868,113 to Jaye etal., herein incorporated by reference, sets forth the amino acidsequences of each form of HBGF. HBGF-1 thus includes any biologicallyactive peptide, including precursors, truncated or other modified forms,or mutants thereof that exhibit the biological activities, or a subsetthereof, of HBGF-1.

Two substances commonly used in injections to “dissolve” fat arephosphatidylcholine (PPC) and sodium deoxycholate. The present inventionutilizes multiple sessions and many injections of the chemicals.Mesotherapy is a more general term for a variety of minimally invasivetechniques in which different medications are directly injected into theskin and the layer beneath the skin for many reasons includingmusculoskeletal problems, neurological problems and cosmetic conditions.Lipodissolve or lipotherapy, or several other terms, refers specificallyto the treatment of fat deposits thru injections.

Other growth factors, mesotherapy and lipotherapy drugs may also beknown to those of skill in the art by alternative nomenclature.Accordingly, reference herein to a particular growth factor by one namealso includes any other names by which the factor is known to those ofskill in the art and also includes any biologically active derivativesor precursors, truncated mutant, or otherwise modified forms thereof.

U.S. Pat. No. 7,094,252 issued Aug. 22, 2006 entitled ENHANCEDNONINVASIVE COLLAGEN REMODELING, U.S. Pat. No. 7,217,265 issued May 15,2007 entitled TREATMENT OF CELLULITE WITH MID-INFRARED RADIATION, andU.S. patent application Ser. No. 11/612,324 filed Dec. 18, 2006 entitledENDOVENOUS LASER TREATMENT GENERATING REDUCED BLOOD COAGULATION, are allincorporated herein by reference in their entireties.

Unless defined otherwise, all technical and scientific terms used hereinhave the same meaning as commonly understood by one of ordinary skill inthe art to which the present invention belongs. Although any methods andmaterials similar or equivalent to those described can be used in thepractice or testing of the present invention, the methods and materialsare now described. All publications and patent documents referenced inthe present invention are incorporated herein by reference.

While the principles of the invention have been made clear inillustrative embodiments, there will be immediately obvious to thoseskilled in the art many modifications of structure, arrangement,proportions, the elements, materials, and components used in thepractice of the invention, and otherwise, which are particularly adaptedto specific environments and operative requirements without departingfrom those principles. The appended claims are intended to cover andembrace any and all such modifications, with the limits only of the truepurview, spirit and scope of the invention.

1. A method for treating cellulite and adipose tissue with laser energycomprising the steps of selectively targeting and treating collagenfibers in the connective structure of the tissue located essentially inthe valley areas of the dimples of the cellulite and adipose tissue byphotoacoustic ablation using a variable pulselength laser, andsimultaneously selectively avoiding heating the collagen fibers in theconnective structure of the tissue located essentially on the hill areasof the dimples of the cellulite and adipose tissue as well as avoidingmelting of the fatty tissue of the cellulite and adipose tissue itself.2. A method to treat cellulite and adipose tissue comprising the step ofselectively targeting and treating sub-surface collagen fibers in theconnective structure of the skin by photoacoustic ablation using avariable pulselength laser while simultaneously avoiding melting of thefatty tissue of the cellulite and adipose tissue.
 3. The method of claim2 in which the step of using laser energy having a variable pulselengthfurther comprises the following sequentially performed steps: Initiallydelivering a series of short pulses of laser energy, each short pulsehaving a pulselength of between about 20 and about 100 microseconds tocut and ablate connective tissue and disrupt fatty tissue; andSubsequently delivering a series of long pulses of laser energy, eachlong pulse having a pulselength of between about 0.5 and about 10milliseconds to heat and shrink collagen in order to tighten theoverlying skin.
 4. The method of claim 2 further comprising the step ofapplying laser energy that has simultaneously low fat absorption andrelatively high water absorption.
 5. The method of claim 2 in which thelaser energy has a wavelength in the region of between about 1.25 um andabout 1.60 um.
 6. The method of claim 2 further comprising the use of a1320 nm Nd:YAG laser.
 7. The method of claim 2 in which the laser energyhas a wavelength in the region of between about 1.3 um and about 1.6 um.8. The method of claim 2 in which the laser energy is delivered at arate of between about 10 and about 1000 millijoules of energy per pulse.9. The method of claim 2 in which the laser energy has a wavelengthbetween about 2.9 and about 3.2 um in wavelength.
 10. The method ofclaim 2 in which the laser energy is delivered using an optical fiberdevice utilizing a firing tip constructed of sapphire.
 11. The method ofclaim 2 in which the laser energy is pulsed using a repetition rate ofbetween about 1 and about 100 Hz.
 12. The method of claim 2 in which thelaser energy is delivered through an optical fiber laser delivery deviceof between about 100 and about 1000 um in diameter.
 13. The method ofclaim 2 in which the laser energy is delivered through an angle-firingoptical fiber laser delivery device.
 14. The method of claim 2 furthercomprising the step of applying the laser energy with a percutaneousfiber probe with distal, white hot carbonized firing tip directly toconnective tissue.
 15. The method of claim 2 in which the laser energyis delivered through an forward-firing optical fiber laser deliverydevice.
 16. The method of claim 2 further comprising the step ofstretching and weakening the connective tissue strands in the valleys ofthe cellulite and adipose tissue dimples while simultaneously shrinkingthe connective tissue strands in the hill top surface of the celluliteand adipose tissue dimples, thereby creating an inward pull generated atthe top of the dimples collectively such that the appearance ofcellulite and adipose tissue is eliminated and skin surface is smoothed.17. The method of claim 2 in which the adipose tissue is in bags beneaththe lower eyelid and the treatment reduces the appearance of the bags.18. The method of claim 2 in which the adipose tissue is on the face andthe treatment reduces the appearance of nasal labial folds.
 19. Themethod of claim 14 further comprising the step of introducing thepercutaneous fiber probe through a cannula member.
 20. The method ofclaim 19 further comprising the step of extending the firing tip of thepercutaneous fiber probe beyond a distal end of the cannula prior todelivery of the laser energy.
 21. The method of claim 2 in which thestep of selectively targeting and treating collagen fibers in theconnective structure of the tissue with heat further comprises cuttingthe collagen fibers in the connective structure with the laser energy.22. A device for the percutaneous treatment of cellulite and adiposetissue with laser energy, the device comprising: a hollow cannula with ablunt tip at a distal end for placement underneath the skin of apatient, said hollow cannula having an opening at the distal end; avariable pulselength laser source having emitting characteristics forgenerating a laser beam that causes the ablation of undesirableconnective tissue; and a coated optical fiber connected to said variablepulselength laser source and disposed within the hollow cannula toconvey the laser beam from said source to a point substantially beyondthe distal end of the cannula.
 23. The device of claim 22 wherein saidvariable pulselength laser source emits at a wavelength between about1.3 um and about 1.6 um.
 24. The device of claim 22 that includescombining injections of a compound into the sub dermal area with thevariable pulselength percutaneous laser energy delivery.
 25. The deviceof claim 24 in which the compound includes one or more of the followingingredients: phosphatidyl choline, sodium deoxycholate, multivitamins,alpha lipid acid, enzymes, non-steroidal anti-inflammatory medications,antibiotics and hormones, other mesotherapy, lipotherapy or lipodissolvedrugs.
 26. The device of claim 24 in which cannula used for introducingthe laser fiber is also used for delivery of the compounds therethrough.27. The device of claim 24 in which delivery of the compounds isconcentrated in areas of cellulite that have excessive fat.
 28. A methodfor the destruction of connective structure in cellulite and adiposetissue, the method comprising the steps of: providing a hollow cannulawith a blunt tip; providing a variable pulselength laser source withemitting characteristics for generating a laser beam having an intensityand a wavelength for causing ablation of connective structure incellulite and adipose tissue; generating a variable pulselength laserbeam with said variable pulselength laser source; arranging an opticalfiber inside said cannula with another end of said fiber connected to anoutput of said variable pulselength laser source; placing the blunt tipof the cannula underneath the skin of a patient and bringing a distalfiring tip of said optical fiber beyond the tip of the cannula andadjacent connective structure of tissue in the cellulite and adiposetissue; and irradiating said connective structure in the cellulite andadipose tissue with said variable pulselength laser beam to causephotoacoustic ablation of the connective structure of the tissue. 29.The method of claim 28 further comprising the following step: generatingsaid variable pulselength laser beam to cauterize blood vessels in thetissue damaged by said irradiating.
 30. The method of claim 28 furthercomprising the following step: irradiating the connective tissue withanother light beam to provide transcutaneous vision.
 31. A method fortreating cellulite and adipose tissue in a patient, the methodcomprising the steps of: providing a hollow cannula with a blunt tip andan optical fiber inside said cannula with one end of said optical fiberextendable through the cannula and beyond the blunt tip of said cannula;generating a variable pulselength laser beam through said optical fiberwith an intensity and a wavelength for ablating the connective structureof the tissue; moving said tip of said optical fiber beyond the blunttip of said cannula into connective structure of the tissue of thepatient; and irradiating connective structure of the tissue with saidvariable pulselength laser beam from said optical fiber to causephotoacoustic ablation of the connective tissue.
 32. The method of claim31 in which the adipose tissue is in bags beneath the lower eyelid andthe treatment reduces the appearance of the bags.
 33. The method ofclaim 31 in which the adipose tissue is on the face and the treatmentreduces the appearance of nasal labial folds.
 34. A device for thepercutaneous treatment of cellulite and adipose tissue with laserenergy, the device comprising: a hollow cannula with a blunt tip at adistal end for placement underneath the skin of a patient, said hollowcannula having an opening at the distal end; a laser source havingemitting characteristics for generating a laser beam that causes theablation of undesirable connective tissue; a coated optical fiberconnected to said laser source and disposed within the hollow cannula toconvey the laser beam from said source to a point substantially beyondthe distal end of the cannula; and an injector mechanism for delivery ofcompounds such as for wound healing compounds meseotherapy andlipotherapy or lipodissolve drugs to the treatment site through thehollow cannula.
 35. A method for the destruction of connective structurein cellulite and adipose tissue, the method comprising the steps of:providing a hollow cannula with a blunt tip; providing a laser sourcewith emitting characteristics for generating a laser beam having anintensity and a wavelength for causing ablation of connective structurein tissue in cellulite and adipose tissue; generating a laser beam withsaid laser source; arranging an optical fiber inside said cannula withanother end of said fiber connected to an output of said laser source;placing the blunt tip of the cannula underneath the skin of a patientand bringing a distal firing tip of said optical fiber beyond the tip ofthe cannula and adjacent connective structure of tissue in the celluliteand adipose tissue; irradiating said connective structure in thecellulite and adipose tissue with said laser beam to cause photoacousticablation of the connective structure of the tissue; and delivering woundhealing compounds, lipotherapy and/or meseotherapy drugs through thehollow cannula to adjacent the laser treated connective structure incellulite and adipose tissue.